Provider First Line Business Practice Location Address:
GOTTCHALK MEDICAL PLAZA 1 MEDCAL PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92697-1447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-824-8600
Provider Business Practice Location Address Fax Number:
949-824-1589
Provider Enumeration Date:
10/23/2006